Healthcare Provider Details

I. General information

NPI: 1326037888
Provider Name (Legal Business Name): MELPO CSP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 12/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 CALLE ARZUAGA SUITE 605
SAN JUAN PR
00925-3321
US

IV. Provider business mailing address

112 CALLE ARZUAGA SUITE 605
SAN JUAN PR
00925-3321
US

V. Phone/Fax

Practice location:
  • Phone: 787-765-3164
  • Fax: 787-763-0200
Mailing address:
  • Phone: 787-765-3164
  • Fax: 787-763-0200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. LUIS H MELENDEZ POVENTUN
Title or Position: PRESIDENT/OWNER
Credential: MD
Phone: 787-547-3933